Sinus headache or sign-us up for a migraine consultation

Paul G. Mathew, MD, FAAN, FAHS

As a headache specialist, the topic of sinus headache is a frequent point of discussion. Many patients deny that they have migraines, believing sinus problems are the cause of their headaches. Some of the more tech-savvy patients believe that they have both migraines and sinus headaches after consulting with “Dr. Google.” The reality of the situation is that 86% or more of patients who suspect that they have sinus headaches in fact have migraines.

Why the confusion between sinus headaches and migraines?

It begins with the many symptoms that both migraines and sinus headaches share, which include pressure in the face, an association with barometric/seasonal weather changes, and autonomic nervous system dysfunction. The autonomic nervous system controls many of the involuntary functions in your body including heart rate, blood pressure, and sweating. In the case of migraines, autonomic dysfunction can cause eye redness, eyelid swelling/drooping, tearing, sinus congestion, and even a runny nose.

Response to treatment can also further drive patients to believe that they have sinus headaches rather than migraines. For example, a patient may have a headache involving a pressure sensation in the face, and calls their primary care physician thinking a sinus infection is causing the symptoms. The primary care physician then prescribes antibiotics and steroids to treat this assumed sinus infection. The patient feels better after taking these medications, and believes that the infection is cured. The reality of the situation is that steroids can be effective for the treatment of sinus issues and migraines. Even without steroids, antibiotics can be perceived as an effective treatment for two reasons. First, the patient truly believes he or she has an infection, so the antibiotic has a powerful placebo effect. The other reason is that with time, the migraine would have gone away anyway.

Unfortunately, this cycle of antibiotics with or without steroids for the treatment of a migraine masquerading as a sinus infection can go on periodically over years and even decades. Taking steroids can cause many problems including weight gain, hair loss, and bone weakness. Inappropriate use of antibiotics can contribute to the rise of antibiotic-resistant bacteria. Conversely, if a sinus headache responds to a migraine-specific treatment like sumatriptan, migraine is more likely the diagnosis than sinus headache.

Here’s why you want to know whether you have migraines and not sinus headaches

An incorrect diagnosis of sinus headaches can also serve to skew a patient’s family history. Migraine is a genetic disorder that is passed down through family members. Patients often deny that any of their family members have migraines, but when asked about sinus headaches, they will often respond, “Actually, my mother had sinus headaches.” When questioned about the mother’s sinus headache behavior, the same patients frequently respond, “She would lay down, and insist that the room be dark and quiet. She would also ask for a bucket to be placed by the head of the bed even though she rarely ever threw up.” Such responses tend to lead the physician and patient to the conclusion that migraines actually do run in the family, as sinus headaches are not typically accompanied by light sensitivity, sound sensitivity, and nausea. The same patients will also return for a follow-up appointment noting, “It turns out that my sister, cousin, and aunt all have migraines, which they thought were due to sinus problems.” In a jocular way, I at times reply, “Discovering family members that suffer from migraines can be both unfortunate and comforting, but such discovery is not as devastating as routinely encountering a family member who regularly causes headaches, which I refer to as ‘mother-in-law syndrome.’”

Three telltale signs it’s a sinus headache and not a migraine

While I was lecturing on distinguishing sinus headache from migraine with some Harvard medical students, they came up with the phrase Mathew’s Sinus Triad to encompass three features that are more suggestive of sinus headache than migraine. These are:

  1. Thick, infectious looking mucous. A little clear drainage can be seen with a number of conditions, and is not necessarily indicative of a sinus infection.
  2. Fever. It would be very unusual for migraine to present with fever, but fever is a primary symptom of a sinus infection.
  3. Imaging. If an imaging study or evaluation with an endoscope looking up the nose shows a sinus problem, then the headaches are likely related to that — unless the headaches continue after the sinus problem is successfully treated.

In conclusion, if you suffer from frequent sinus headaches, there is a good chance that you are actually experiencing migraines. Making the correct diagnosis and formulating an appropriate treatment plan can reduce the frequency and intensity of headaches, as well as avoid unnecessary testing, visits to specialists, and taking medicines that are not actually treating the problem.

Comments:

  1. Paula

    I used to suffer sinus headaches all the time. I never knew the difference until I had a migraine. What a huge difference. The pain of a migraine was so much more intense I could barely move and needed to lay under the covers with a pillow over my eyes to block out light and sound. It was the most horrific pain ever. I didn’t even want anyone to breath on me the pain was so bad.

    Then I moved to Austin and found I was starting to get sinus headaches from Cedar allergies. Apparently cedar allergies are a big thing here. I had done the route of allergists to try to avoid the sinus headaches, but they started getting really bad again.

    Then I found out that some chiropractors use an instrument called an activator that is gentle and precise and that this kind of chiropractic care can knock out headaches. I was skeptical, but decided I didn’t have anything to lose by trying it and if it helped at all I would be so much better off. I researched it a lot and then decided on Stakes Chiropractic Center in Austin because he was an advanced certified in that technique and now it really doesn’t matter what is causing the headache, usually before I leave Dr. Stakes office the headache is all gone or almost all gone. I would have bet BIG money it wouldn’t work but I’m grateful especially at this time of year when the craziness gets out of control that I don’t have to pop pain relievers. I’ve had kids, and headaches, especially migraines are some of the worst pain I’ve ever experienced. Right up there with a tooth infection.

  2. آب معدنی

    unfortunately it’s been years that i suffer from sinus headaches & and my doctors always told me its migraine! in my experience sinus headaches are the side effect of cold wind on the sinus areas! any way thank nice article

  3. Terrence forest

    I’ve been suffering with this lately. Great info. Thanks